Research roundup: The effects of cancer on sexuality and quality of life
Adolescents and young adults increasingly are diagnosed with cancer, while advances in treatment have increased rates of survival across a wide range of cancer diagnoses. Researchers increasingly focus on anxiety and depression, as well as how both physical and psychological effects impact cancer patients’ social well-being — for example, sexual functioning, sense of intimacy/isolation and overall quality of life.
The following studies examined disruptions to sexual functioning and quality of life as a result of a cancer diagnosis and treatment as differentially experienced based on demographic factors such as age and gender, with particular attention paid to female breast cancer survivors.
In addition to reviewing the following research summaries, psychologists are encouraged to explore the literature more completely to determine what may be useful to them in practice.
Geue, K., Sender, A., Schmidt, R., Richter, D., Hinz, A., Schulte, T., Brahler, E. & Stobel-Richter, Y. (2014). Gender-specific quality of life after cancer in young adulthood: A comparison with the general population. Quality of Life Research, 23(4) 1377-1386. Doi: 10.1007/s11136-013-0559-6
The authors conducted a cross-sectional study of 117 adolescent and young adult cancer patients between the ages of 18 and 39 years old who had recently completed acute medical treatment. Participants had been given a cancer diagnosis no more than five years prior to the survey, were at least 15 years of age at the time of diagnosis and were enlisted from medical facilities. For male participants, the most frequent diagnosis was hematologic neoplasm (55 percent) followed by testicular cancer (27.5 percent). The majority of female participants had a diagnosis of breast cancer (53.3 percent) or hematologic neoplasm (26 percent). Chemotherapy was the most commonly received treatment amongst all participants (82.9 percent). A representative comparison sample of participants at least 14 years old without a cancer diagnosis was also recruited.
Participants completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), a self-report measure created specifically for cancer patients. It contains five function scales (physical, role, emotional, cognitive and social), three symptom scales (fatigue, nausea and pain), six single item questions (dyspnea, insomnia, loss of appetite, constipation, diarrhea and financial difficulties), and one global quality of life (QoL) scale. Higher scores on the function scales demonstrate higher levels of functioning, while higher scores on symptom/single item scales illustrate more marked symptoms.
Adolescent and young adult participants with a cancer diagnosis reported a substantially reduced quality of life compared to the representative group without a cancer diagnosis. Specifically, participants with a cancer diagnosis reported worse emotional and social functioning, and greater fatigue and financial difficulties. Compared to male participants in the study, female participants with a cancer diagnosis reported poorer quality of life, with significant impairments in cognitive functioning.
Even after the completion of treatment, adolescents and young adults with cancer diagnoses report significantly impaired quality of life. Addressing the expectations and concerns about the impact of cancer diagnosis and treatment on quality of life for adolescent and young adult patients, especially in female patients, might help to reduce the negative impact on their social and emotional well-being, as well as aid in readjustment to life after cancer. For example, recommending that both males and females in treatment join a support group with other young cancer patients may help reduce social isolation through the sharing of similar experiences.
Krok, J., Baker, T. & McMillan, S. (2013). Sexual activity and body image: Examining gender variability and the influence of psychological distress in cancer patients. Journal of Gender Studies, 22(4), 409-422. Doi: 10.1080/09589236.2012.708828
This study examined 232 adult cancer patients receiving out-patient treatments and how their illness affects their body image and sexual activity. All participants had a diagnosis of cancer, in any stage. Lymphoma (29 percent) and lung cancer (15 percent) were the most common forms of cancer in the male participants, while breast cancer (29 percent) and lymphoma (17 percent) were the most frequent types in the female participants.
Psychological distress, along with the severity and frequency with which common symptoms of cancer contribute to distress, was measured with the Memorial Symptom Assessment Scale (MSAS) psychological distress subscale (PSYCH) examining worry, nervousness and difficulty concentrating. Two single-item questions to appraise body image and issues with sexual interest and activity were added. Higher scores were equated with more severe symptoms.
The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) measure and single-item questions that focused on the site, stage and pain level of the cancer were used to assess participants’ physical health.
While both male and female participants reported psychological distress, women more frequently experienced problems with concentration, nervousness, sadness, worry and dissatisfaction with body image. Men expressed greater severity of psychological distress symptoms, although the difference was not statistically significant. No significant differences were seen between men and women in regard to sleeping difficulty, irritability or problems with sexual interest and activity. Both men and women cited a lack of sexual interest and activity as the most serious psychological symptom, especially among younger adults and participants who were married.
Individuals with cancer still desire intimacy and sexual relationships yet find it difficult due to lack of interest, changes in their body, low energy or other challenges. Yet frequently, cancer treatment does not focus on this aspect of life. Recognizing these desires and challenges in their patients provides an important avenue for psychologists to have an impact on improving psycho-social quality of life. For example, by routinely assessing disruptions in body image and problems with sexual interest and activity in patients who have been diagnosed with cancer, psychologists are afforded the opportunity to improve care by addressing concerns, normalizing experiences and helping individuals find new approaches to meeting needs.
Ussher, J., Perez, J. & Gilbert, E. (2012). Changes to sexual well-being and intimacy after breast cancer. Cancer Nursing, 35(6), 456-465.Doi: 10.1097/NCC.0b013e3182395401
The sexual well-being of individuals with breast cancer was investigated, as well as the quality of intimacy with their partners. An online survey was completed by 1,965 mostly female participants. The majority of participants reported that their breast cancer or treatment for breast cancer negatively impacted their sexual well-being. The three most frequently reported disruptions included declines in the frequency of sex (78 percent), energy for sex (76 percent) and sexual arousal (74 percent). When asked why breast cancer and/or breast cancer treatment affected their sexual well-being, participants cited tiredness (71 percent), vaginal dryness (63 percent), hot flashes (51 percent) and feeling unattractive (51 percent) as the most common reasons. Twenty-four percent reported that their breast cancer had “dramatically” affected their sexual relationship.
In response to a number of open-ended questions answered by a subsample of participants, 35 percent described their sex lives after battling breast cancer as “depressing” and “devastating.” Many of the respondents struggled with feelings of loss due to changes in their relationship with their partner. Feelings of unattractiveness and loss of femininity were cited as being detrimental to sexual well-being by nearly 20 percent of participants. Moreover, participants expressed fear that changes in their own sexual well-being were negatively impacting the sexual well-being of their partners.
Despite the disruptions and changes reported by participants, only 25 percent talked to a health professional about their impaired sexual well-being due to breast cancer and/or breast cancer treatment. Psychologists may want to engage their patients in discussions regarding sexual well-being and partner intimacy among those battling breast cancer and/or receiving cancer treatment as well as help those individuals develop strategies to raise concerns with partners and physical health care providers.
Safarinejad, M., Sharfiei, N. &Safarinejad, S. (2013). Quality of life and sexual functioning in young women with early-stage breast cancer 1 year after lumpectomy. Psychooncology, 22(6), 1242-1248.Doi: 10.10002/pon.3130.
Women with a diagnosis of breast cancer (n = 186) who had undergone a lumpectomy at least one year prior to recruitment, were surveyed on quality of life (QoL), sexual functioning and self-esteem and compared to an age-matched group of women without breast cancer (n = 204). Participants were between the ages of 25 and 45.
Participants completed the Female Sexual Function Index to measure sexual dysfunction, the Short Form-36 Health Survey to assess QoL and the Rosenberg Self-Esteem Questionnaire. Additionally, participants were asked a single item assessing their level of sexual satisfaction.
Female sexual dysfunction (FSD) in the participants with breast cancer was more common than in participants without cancer (52.5 percent vs. 28.7 percent). Desire, arousal, orgasmic, pain and lubrication disorders were all more significantly frequent in participants with breast cancer than in the control group, with lubrication and sexual satisfaction being the most greatly impacted. Patients who received radiotherapy, chemotherapy and hormone therapy treatment were most likely to be sexually dissatisfied and struggle with lubrication disorder. Impairments, however, were not related to differences in self-esteem. Finally, satisfaction with sex life was significantly correlated with overall quality of life (p < .001).
Breast cancer is the most common form of cancer among women. Following cancer treatment, women, especially young women, report experiencing significant impairment in sexual functioning and quality of life. Psychologists can be most helpful to patients by being knowledgeable about how physical and psychological side effects of cancer treatment in turn negatively impact quality of life and sexual functioning, and how to assist their patients in addressing these experiences in treatment.